A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study

被引：97

作者：

Tilz, Roland Richard ^{[1
,2
]}

Schmidt, Vanessa ^{[1
]}

Puererfellner, Helmut ^{[3
]}

Maury, Philippe ^{[7
]}

Chun, K. R. Julian ^{[6
]}

Martinek, Martin ^{[3
]}

Sohns, Christian ^{[4
]}

Schmidt, Boris ^{[6
]}

Mandel, Franck ^{[7
]}

Gandjbakhch, Estelle ^{[8
]}

Laredo, Mikael ^{[9
]}

Gunawardene, Melanie Anuscha ^{[10
]}

Willems, Stephan ^{[10
]}

Beiert, Thomas ^{[11
]}

Borlich, Martin ^{[12
]}

Iden, Leon ^{[12
]}

Fueting, Anna ^{[13
,14
]}

Spittler, Raphael ^{[15
]}

Gaspar, Thomas ^{[16
]}

Richter, Sergio ^{[16
]}

Schade, Anja ^{[17
]}

Kuniss, Malte ^{[18
]}

Neumann, Thomas ^{[18
]}

Francke, Alexander ^{[19
]}

Wunderlich, Carsten ^{[19
]}

Shin, Dong-In ^{[20
,21
]}

Meininghaus, Dirk Grosse ^{[22
]}

Foresti, Mike ^{[23
]}

Bonsels, Marc ^{[23
]}

Reek, David ^{[24
]}

Wiegand, Uwe ^{[25
]}

Bauer, Alexander ^{[26
,27
]}

Metzner, Andreas ^{[28
]}

Eckardt, Lars ^{[29
]}

Popescu, Sorin Tefan ^{[1
]}

Krahnefeld, Olaf ^{[30
]}

Sticherling, Christian ^{[31
]}

Kuehne, Michael ^{[31
]}

Dinh Quang Nguyen ^{[32
]}

Roten, Laurent ^{[33
]}

Saguner, Ardan M. ^{[34
]}

Linz, Dominik ^{[35
,36
]}

van der Voort, Pepijn ^{[37
]}

Mulder, Bart A. ^{[38
]}

Vijgen, Johan ^{[39
]}

Almorad, Alexandre ^{[40
]}

Guenancia, Charles ^{[41
]}

Fauchier, Laurent ^{[42
]}

Boveda, Serge ^{[40
,43
]}

De Greef, Y. ^{[40
,44
]}

机构：

[1] Univ Hosp Schleswig Holstein, Univ Heart Ctr Lubeck, Dept Rhythmol, Ratzeburger Allee 160, D-23538 Lubeck, Germany

[2] German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Lubeck, Germany

[3] Ordensklinikum Linz Elisabethinen, Linz, Austria

[4] Ruhr Univ Bochum, Univ Klin, Kliniken Elektrophysiol Rhythmol, Herz & Diabeteszentrum NRW, Bad Oeynhausen, Germany

[5] Heart Ctr Bremen, Electrophysiol Bremen, Bremen, Germany

[6] MVZ CCB Agaples Markus Krankenhaus, Frankfurt, Germany

[7] Univ Hosp Rangueil, Dept Cardiol, Toulouse, France

[8] Sorbonne Univ, Cardiol Inst, Pitie Salpetriere Univ Hosp, AP HP, Paris, France

[9] Pitie Salpetriere Univ Hosp, AP HP, Cardiol Inst, Paris, France

[10] Asklepios Klin St Georg, Klin Kardiol & Internist Intens Med, Hamburg, Germany

[11] Univ Hosp Bonn, Dept Internal Med 2, Heart Ctr Bonn, Bonn, Germany

[12] Univ Kiel, Acad Teaching Hosp, Heart Ctr, Segeberger Kliniken, Bad Segeberg, Schleswig Holst, Germany

[13] Alfred Krupp Hosp, Dept Electrophysiol, Essen, Germany

[14] Witten Herdecke Univ, Dept Med, Witten, Germany

[15] Univ Hosp Mainz, Ctr Cardiol, Dept Cardiol Electrophysiol 2, Mainz, Germany

[16] Tech Univ Dresden, Herzzentrum Dresden, Univ Clin, Dept Internal & Cardiovasc Med, Dresden, Germany

[17] Helios Hosp Erfurt, Dept Intervent Electrophysiol, Erfurt, Germany

[18] Kerckhoff Heart Ctr, Dept Cardiol, Bad Nauheim, Germany

[19] Helios Klinikum Pirna, Klin Innere Med 2, Pirna, Germany

[20] Helios Clin Krefeld, Heart Ctr Niederrhein, Dept Cardiol, Krefeld, Germany

[21] Univ Witten Herdecke, Fac Hlth, Sch Med, Witten, Germany

[22] Carl Thiem Klinikum gGmbH Cottbus, Dept Cardiol, Cottbus, Germany

[23] Kliniken Maria Hilf GmbH, Monchengladbach, Germany

[24] Univ Hosp Augsburg, Dept Cardiol, Augsburg, Germany

[25] Univ Cologne, Akad Lehrkrankenhaus, Sana Klinikum Remscheid GmbH, Remscheid, Germany

[26] Diak Klinikum Schwabisch Hall, Schwabisch Hall, Germany

[27] Klinikum Crailsheim, Schwabisch Hall, Germany

[28] Univ Klinikum Hamburg Eppendorf, Kardiol Klin, Univ Herz & Gefasszentrum, Hamburg, Germany

[29] Univ Hosp Munster, Dept Cardiol Electrophysiol 2, Munster, Germany

[30] Sana Kliniken Lubeck, Lubeck, Germany

[31] Univ Hosp Basel, Dept Cardiol, Munster, Germany

[32] St Vinzenz Hosp Koln, Cologne, Germany

[33] Univ Bern, Dept Cardiol, Inselspital, Univ Hosp Bern, Basel, Switzerland

[34] Univ Hosp Zurich, Univ Heart Ctr, Dept Cardiol, Zurich, Switzerland

[35] Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht, Netherlands

[36] Cardiovasc Res Inst Maastricht, Maastricht, Netherlands

[37] Catharina Hosp, Eindhoven, Netherlands

[38] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[39] Jessa Hosp, Heart Ctr Hasselt, Hasselt, Belgium

[40] Vrije Univ Brussel, European Reference Networks Guard Heart, Univ Ziekenhuis Brussel, Heart Rhythm Management Ctr,Postgrad Program Card, Brussels, Belgium

[41] Dijon Univ Hosp, Dept Cardiol, Dijon, France

[42] Ctr Hosp Univ Trousseau, Serv Cardiol, Tours, France

[43] Clin Pasteur, Cardiol Heart Rhythm Management Dept, Toulouse, France

[44] ZNA Heart Ctr, Dept Cardiol, Antwerp, Belgium

[45] Jean Monnet Univ, Div Cardiol, Creteil, France

[46] Univ Bordeaux, CHU Bordeaux, IHU LIRYC ANR 10 IAHU 04, Bordeaux, France

[47] La Rochelle Hosp, La Rochelle, France

[48] Univ Hosp Strasbourg, Strasbourg, France

[49] Univ Hosp Poitier, Poitiers, France

[50] Clin Tonkin, Lyon, France

来源：

EUROPEAN HEART JOURNAL | 2023年 / 44卷 / 27期

关键词：

Atrial fibrillation; Catheter ablation; Radiofrequency energy; Oesophageal fistula; PULMONARY VEIN ISOLATION; ATRIOESOPHAGEAL FISTULA; CRYOBALLOON ABLATION; INJURY; PREVALENCE;

D O I：

10.1093/eurheartj/ehad250

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

引用

页码：2458 / 2469

页数：12

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